Best Practice Summary Yeang, Siem Reap Province, Cambodia · Best Practice Summary Yeang, Siem Reap Province, Cambodia Country: ... Yeang is a commune in Siem Reap province consisting

Best Practice Summary Yeang, Siem Reap Province, Cambodia

Country:

Cambodia

Local Government:

Yeang, Siem Reap Province

Type:

Commune

Best Practice Title:

A Local Health Response System in Yeang, Siem Reap

Aspect of Governance:

Thematic Area 1: People Participation in Planning and Decision Making – find out which one.

Reported By:

Working Group for Partnerships in Decentralisation (WGPD)

Start Date:

2012

Contact: Sokhany Prak Cambodian Civil Society Partnership (CCSP) [email protected]

Description: Background Yeang is a commune in Siem Reap province consisting of five villages home to 1050 families. As in many rural areas in Cambodia, residents have difficulty accessing services, such as healthcare. The local community councillor Doch Malin, who faced a personal struggle to manage without healthcare support after her husband’s death, made health a priority for her commune and was inspired to take on a leadership role within the community. Her efforts have been recognised with a provincial best practice award in Siem Reap.

The Challenge Although communes in Cambodia are receiving more responsibility to provide basic healthcare services through the decentralization and deconcentration (D&D) reforms, they often lack the capacity and adequate funds to effectively serve residents. Rural areas, in particular, lack health services and have many residents that are not able to cope with health emergencies when they arise. In these areas, where poverty is often widespread, most residents are unable to pay for healthcare services, including transportation in emergencies. There is not enough emphasis on preventative care or the importance of general check-ups to maintain good health. Citizens are therefore often falling through the cracks and suffer from health issues that could have been prevented or treated easily if recognised early. Residents with HIV/AIDS are particularly vulnerable in this situation as they have specific health needs and face significant barriers due to the stigma of their condition. The problem that needed to be solved therefore was how to bring better healthcare, both in terms of emergency response and preventive care to the community in Yeang. Results Achieved and Relevance to Public Life The project’s activities resulted in a local health response system that is unique and innovative in Cambodia. This system consists of the following elements: 1) Having village chiefs as the first contact person for any emergency Village chiefs as the people with the highest authority and the ability to draw on transport resources as well as to coordinate efforts were brought into the project to act as local coordinators in case of an emergency. 2) Provision of transportation Since transport to a health centre or hospital is often one of the most important elements in an emergency, the provision of transport to the nearest and most appropriate health facility for emergency treatment is of vital importance. The local village chiefs coordinating role includes the organisation of appropriate transport in cases of emergencies. 3) A budget for emergency transportation The commune covers transportation costs through a budget that is funded by fees collected for issuing documents and other services provided by the council. This transfer of generated funds not only makes the emergency response system sustainable, but also establishes health as a central priority for villages within the Yeang commune.

4) Preventative healthcare The project also resulted in preventative healthcare by promoting awareness on general health maintenance amongst the population. Through cooperation with the Committee for Women and Children as well as the Village Health Support Group, it was possible to reach out to local people in village gatherings and encourage residents to visit health centres or hospitals for check-ups rather than wait until they become sick and need medical care. 5) Addressing HIV/AIDS discrimination The stigma surrounding HIV/AIDS positive people within the commune was identified as a large social problem. The leadership of the commune councillor in interacting directly with HIV/AIDS patient helped to dispel myth surrounding the condition. Main Activities 1) Planning and communication Planning and communication activities were the most important element in getting the project started. The commune councillor who initiated the health response system began by bringing together the commune’s five village chiefs to devise a response plan. 2) Setting up an emergency transport system The village chiefs agreed to take on the responsibility for identifying and organising suitable transportation to the nearest and most appropriate health facility for emergency treatment. As a back up the commune councillor was herself available to be contacted in case there is a problem with organising transportation. 3) Setting up a financial system to pay for emergency transport To ensure that there was a budget available to pay for emergency transportation, it was decided that funds raised through fees collected for issuing documents and other services that the council provided, would be used to pay for emergency transport. An accountancy system to ensure the transfer of funds was set up. 4) Devising a procedure to encourage preventive healthcare Since there was no tradition of seeking advice on health issues or taking preventative actions, the commune councillor enlisted the support of the Committee for Women and Children as well as the Village Health Support Group. With their cooperation, it was possible to reach out to local people in

village gatherings and encourage residents to visit health centres or hospitals for check-ups rather than wait until they become sick and need medical care. 5) Dispelling myth about HIV/AIDS To address the issue of discrimination against HIV/AIDS sufferers which not only affected the victims socially, but also economically, the commune councillor and other leadings members of the community publicly interacted with HIV/AIDS patients and explained to citizens about the myths around transmission. This included buying baked goods from and interacting socially with a family with members with HIV who had not been able to sell their products due to misconceptions about how the virus is transmitted.

Lessons Learnt The following are recommendations for other communes/councils that are keen on improving their basic health services: 1) NGOs and CSOs should lobby their commune councils to consider emergency response systems that provide solutions to the poorest residents that may be unable to locate or pay for transportation. 2) All local stakeholders should work together to find acceptable ways to generate income to support an emergency transportation budget that can be managed by the local commune council. 3) NGOs and CSOs should work directly with commune councils on awareness raising campaigns. 4) Vulnerable groups in the community that may face barriers in healthcare or from health issues should be identified and supported by the commune councilors and NGO/CSO leaders. Sustainability One of the greatest challenges of developing this local health system has been the difficulty in sustaining a budget, since the income generated has not always been enough to meet the expenses, especially of the emergency transportation. For the project to remain sustainable, sound and creative ways of raising funds need to be found. Transferability The project is eminently transferable as long as there is willingness within the commune and cooperation amongst the relevant stakeholders and between NGOs and councillors. The main cost items to be budgeted for is emergency transportation.

Picture 1: Yeang commune residents know that they can get transportation to a health facility in an emergency situation.

Picture 2: Commune councillor Doch Malin, the initiator of the project.